Impact of antithrombotic treatment on clinical outcomes after craniotomy for unruptured intracranial aneurysm

Objective: Patients receiving antithrombotic treatment occasionally undergo craniotomy. We aimed to explore the impact of perioperative use of antithrombotic agents on the occurrence of surgical complications and clinical outcomes in patients with unruptured intracranial aneurysm (UIA).

Patients and methods: We retrospectively analyzed 401 consecutive patients who had undergone craniotomy for UIA at our institution between January 2006 and December 2016. Patients were divided into two groups: those who received oral antiplatelet and/or anticoagulant agents during the perioperative period (antithrombotic treatment group, n=45); and those who did not (no antithrombotic treatment group, n=356). In the antithrombotic treatment group, 40 patients received antiplatelet alone, 2 received anticoagulant alone, and 3 received antiplatelet plus anticoagulant.

Results: The two groups showed no significant differences in mortality, morbidity, or occurrence of symptomatic brain infarction, but intracranial hemorrhage was more frequent in the antithrombotic treatment group than in the no antithrombotic treatment group (p=0.0187). Multivariate analysis revealed posterior location of the aneurysm (odds ratio (OR), 8.10; 95% confidence interval (CI), 2.77-23.68; p=0.0001) and surgical procedure (OR, 5.48; 95%CI, 1.68-17.86; p=0.0048) as significantly correlated with severe morbidity, and intracranial hemorrhage as correlated significantly with antithrombotic treatment (OR, 3.83; 95%CI, 1.36-10.76; p=0.0110).

Conclusions: This study provides important information about the occurrence of intracranial hemorrhage and clinical outcomes in patients undergoing antithrombotic treatment during the perioperative period of craniotomy for UIA.